A 48-year-old woman with ankylosing spondylitis presents 2 weeks after a minor motor vehicle accident with acute severe mid-thoracic pain. Imaging shows a three-column fracture through an ankylosed T7-T8 segment with minimal displacement. The optimal management is:

• A TLSO brace and bed rest for 6 weeks
• B Percutaneous vertebroplasty
• C Anterior corpectomy with cage reconstruction
• D Posterior long-segment instrumentation and fusion (pedicle screws 3 levels above and below) ✓

Explanation

Ankylosed spine fractures behave like long bone fractures with high instability and nonunion risk. Long-segment posterior fixation (minimum 3 levels above and below) is the standard surgical treatment due to the brittle bone and lever-arm mechanics. Brace management carries high failure and neurologic deterioration risk. Anterior surgery alone is insufficient. Vertebroplasty is contraindicated in three-column injuries with posterior involvement.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.